Quality Land

Mª Luisa de la Puente
 

In the world of healthcare, quality is everyone's business and it covers everything. This assertion, generically true but with little operational, is coming in stronger in recent years. This concretion to a specific context is driven by the necessary adaptation to the escalation of healthcare costs, the economic context, the influence of the business world to obtain more performance from resources, the demands of its clients or professional discomfort due to the little recognition of what it is.

Watching Nomadland, I thought of this striking headline to express my perception of the evolution that the concept and organization of quality are having in the healthcare world. It's clear that, if we want to give more quality, more excellence, to the services we offer, and if we want to value professional work in its fair measure, we have to know our stuff. We have to see how we live in the current territory of quality, what QualityLand looks like.

Quality work is based on the identification of good practices, patient safety, evidence guides, protocolization, academic training and, without leaving all this aside, progresses towards results orientation, recognition of the experience of patients and caregivers, the right time, right place, right people, in-service training and digital transformation. And all this counting on involvement and professional leadership as a fundamental engine of change.

How can we carry out this radical transformation, which, moreover, must be done specifically from the reality of each one and of each institution, since there is only transformation when it starts from the context itself? No matter how much consulting you incorporate, no matter how much you read or watch what others are doing, you have to get down to work. No one can do it for you.

There is a good deal of agreement, and much has been written in this blog about it, that the new objectives for improving quality in health institutions, be they hospital, primary, mental or intermediate (social health) care, should focus on :

• Adopt evidence-based standards and protocols of care to obtain the best results for patients.
• Eliminate or reduce adverse events, that is, errors in healthcare that cause harm to the patient.
• Improve the experience for patients and caregivers.
• Improve professional satisfaction.
• Reduce the costs of the activity derived from unnecessary techniques or treatments.
• Increase the transparency of the results of the previous points for citizens and professionals.

The new concept of care quality implies orienting itself to these objectives. To do this, according to the experience described so far, the institutions should internally manage the following aspects (we exclude here the external means of financing and contracting, which are fundamental, but in which we do not enter):

• Be equipped with new figures capable of working with new instruments and technologies (experience gathering, process management, computer engineering, team leadership, statistics, technology to help decision-making and security alerts...) that complement the more traditional profiles that are still needed. There is quite a bit of literature on this and we cite an example.
• Build cross-disciplinary interdisciplinary work teams made up of the technicians described above and the healthcare professionals and managers involved.
• Count on healthcare professionals as leaders in the management of change.
• Include patients in decision making.
• Train expert technicians but also healthcare professionals and managers in the new concepts and quality instruments. (1)
• Create networks between similar centres to learn from each other.
• Build indicators to monitor the change in quality, such as mortality, complications, safety, the experience of patients and professionals, the reduction of low-value practices ...
• Have the support of institutions and external consultancies experienced during the transformation journey. The fact that others cannot do it for you doesn't mean that it's not very good to have them accompany you (see in this sense Virginia Mason's support for NHS hospitals as an example in this video).

This conceptual and organizational innovation, the new QualityLand, can only arise from a firm commitment by the management of the centres, providing it with the necessary organizational and financial support. Because, let's not fool ourselves, if this impulse doesn't exist, it will be very difficult to carry out the necessary and much-desired transformations but that cost us so much. Acting decisively doesn't imply doing everything right away, but you have to move slowly but surely through the continuous improvement of health care.

1. In this sense, in our environment, multiple courses and training instruments have been appearing in recent years, such as, among others: Clinical Management, Assistive and Legal Security and Quality, Evaluation and improvement of quality in the health sector, Innovation in care processes amb oriented to results, Patient experiences.